Dei'ah veDibur - Information & Insight

A Window into the Chareidi World

13 Teves 5763 - December 18, 2002 | Mordecai Plaut, director Published Weekly









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Home and Family

Your Medical Questions Answered!
by Joseph B. Leibman, MD

Diplomate, Board Certification of Emergency Medicine

Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua Hospital

We just completed our series on pregnancy and it would be a logical continuation to speak about children, a subject we have spoken about in the past. But it is worthwhile reviewing.

Pediatricians see different diseases and have different approaches to disease based on the age group of the patient. Neonates are different than infants up to three months old. They in turn are different than infants up to a year old, who are different than children up to adolescence. Adolescents are very similar to adults.

Let's use as an example a very common problem, that of fever. Fever within a few days of birth is a dangerous condition; many infections that you and I would have no problem with can cause havoc and serious problems at this age. Strep we spoke about in the previous series, listeria, chicken pox and the TORCH organisms are also causes for worry. From one week until about 60 days, babies with fevers above 38 (100.4) are generally admitted to the hospital and receive full culturing which includes a spinal tap -- a scary test for parents, but a very safe test, as spinal taps in that age group are not difficult. Getting urine may be more frustrating. They are however good in my opinion for older infants as a screen for infection, as a culture may not be necessary if the urine in the bag is clean. Often a catheter must be inserted or urine taken from the bladder with a needle puncturing through the abdominal wall. Again, this is a scary thing for parents, but routine.

Let me interject at this point that it is better to leave the room than to become hysterical while the doctor does these procedures. Fainting by parents is especially in bad taste. Let me also add that putting in an IV line at this age and up to one year can be especially challenging and the child will cry and scream. A doctor who experiences difficulty in the insertion of an IV line is not to be thought of as a bad doctor. A good parent helps the physician by soothing the child, remaining calm, and being encouraging.

Remember in this age group the child can not tell us what is wrong and urinary tract infections are commonly missed and can be occult. The same goes with all age groups until adolescence. Also up to one year, normal signs of meningitis are absent, making a spinal tap a commonly done procedure if there is any possibility of this horrible disease,

Fever in an older infant and child is investigated in a more focused manner. Here we recognize that often children will not localize their area of discomfort. An ear infection may cause them to complain that their tummy hurts. We check the more common places of infection and make sure there is close follow up just in case a more localized area of infection doesn't appear. I do not believe that while we are waiting for the infection to localize that we should use antibiotics indiscriminately, and certainly not the strongest ones. Also, the height of fever doesn't correspond to the severity of infection. We'll discuss this more in the next column. Write me in care of the Yated.

A message from Glaxo, sponsor of this column. I wrote that one should not use antibiotics without a clear reason, and this certainly applies to Augmentin and Zinnat. However, these drugs are indicated for tough infections and I am confident that when I do need the strength of a stronger antibiotic that these drugs will perform. You can depend on Augmentin and Zinnat.


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